ROAD AMERICA April, 2010

REGISTRATION FORM

 

There will be four (4) groups with about thirty (30) cars in each session. If you would like to be assigned to two (2) groups, a filled out registration form is required per group.
Cost per group:  $455 for the weekend and $255 for a single day
 

 

PLEASE PRINT SIGN AND MAIL IN ALL FORMS

 

Mail to:

MFBA
Attn: Carmen Drays
4924 Fielding Road
Rockford, IL 61102

 

PLEASE SUBMIT ELECTRONICALLY WITH THE "SUBMIT" BUTTON BELOW

OR COPY & PASTE THIS PAGE INTO AN EMAIL TO roadamerica@fbody.us

 

 

 

Personal Information:

Name:   Last First MI Over 18 years of age: yes no

Address City

State Zip Code

Home Phone -- ext. Alternate Phone - - ext.

Email Address (required for confirmation) IM Handle and Format (AIM/MSN)

Emergency Contact Phone - -

Will they be at the track? Yes No

Vehicle Information

Year Make Model Color

 

Questions about your Car (please select one):

Brakes: Stock Aftermarket Street/Track Aftermarket Track only

Tires: Stock Aftermarket Street/Track Aftermarket Track only

Suspension: Stock Aftermarket Street/Track Aftermarket Track only

 

Car Numbers

(Car numbers will be assigned by request on a first come first served basis)

Last event number: Would you like to keep it: Yes No

Car Number Request: 1st Choice     2nd Choice    3rd Choice  

Do you have numbers for your car  Yes No

 

Event History

How many times will you have participated in the MFBA event at Road America?

(Please select one)  0 1  2 3 4 5 More than 5

Type of events you participated in before (Competitive/non-competitive and which track):

:

If you participated in one of our events before what group did you run in: Novice (Group D) Intermediate (Group C) Advanced (Group B) Assertive (Group A)

Did you like being in that group: Yes No

Do you know your lap times? Yes - Time: No

Based on your Experience and Driving style, please select a Driving Group: (please select one from our definitions that fits you) (How to rate yourself)

  Novice (Group D) Intermediate (Group C) Advanced (Group B) Assertive (Group A) Not Sure

Do you feel comfortable passing and being passed at high speeds? Yes No

After you fill out the form
Please Print, sign and mail your forms!
(Make checks payable to MFBA)

 

Cost per group:  $455 for the weekend and $255 for a single day  

                                                                             

 

Wherefore, I have read and hereby agree to all of the terms and conditions as set forth in the registration and liability forms and release the Midwest F-body Association from any liability or future claims.

 

Signature: _________________________________  Date:_________


To better serve you we would ask if you could submit the results so all the information can be received accurately.  Thank You.

* tax included in price

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